Across the spectrum of cancer types, outcomes research has demonstrated that the quality of cancer care varies in the United States (US). Understanding this variation and, more importantly, how to correct it is the future direction for cancer health services research. This proposal seeks to understand and address the barriers to evidence-based cancer care while providing the career development candidate with a very rich research training and mentorship experience. The research proposal focuses specifically on the quality of surgical care for rectal cancer, which is diagnosed in more than 40,000 Americans each year. There is strong evidence linking the use of evidence-based surgical practices with improved outcomes for this disease. However, variation in the use of evidence-based practices and treatment outcomes for rectal cancer has been demonstrated, suggesting opportunities to improve the quality of care. The proposal's research aims include (1) assessing hospitals' compliance with evidence-based practices for rectal cancer, within the setting of an existing surgical quality-improvement organization; (2) qualitatively assessing barriers to uptake of evidence- based practices; and (3) designing and evaluating an intervention to increase use of evidence-based practices. This project, the multidisciplinary mentorship team, and the research environment are ideally suited to address the career goals and educational needs of the candidate, Samantha Hendren, MD, MPH. Dr. Hendren is a board-certified colorectal surgeon with a clinical and research interest in colorectal neoplasms. Her prior research experience with measuring cancer outcomes and interventions to optimize cancer care has prepared her for this proposal. However, to achieve her career goal of improving colorectal cancer care through hospital-based quality-improvement programs, she will need additional training. Educational goals, including obtaining expertise in implementation science, advanced statistical methods for comparing hospital performance, and organization of collaborative programs, are feasible with the grant's educational plan and highly accomplished mentorship team. The educational program includes graduate-level courses in qualitative methods, hierarchical modeling, and health communications, as well as travel to centers of excellence and relevant national conferences. In summary, this research project, mentor team, and educational plan will lay the groundwork for Dr. Hendren to perform ongoing, innovative, independent research to improve colorectal cancer treatment and outcomes.